Required Patient Information

All Patients must have up to date personal information on file with the clinic. Intake forms are available at registration and updated annually.

New Patients

Please print the appropriate forms below. Fill them in, and bring them to your first visit. Filling them out in advance allows you to carefully consider the questions, provide complete answers, and it saves valuable time during the appointment. You may also bring any supplemental information that you feel is important.

Established Patients

Please let us know if there are any changes to your personal, insurance, or health information. Print the appropriate forms below and fill in the updated information. Bring the form and any other related information to your next visit so we can update our records. This will allow us to provide the best care possible, and reduce errors in billing.

Forms:

• General Information and Health History (Required)
  This form provides the basic history and insurance information we need to create your medical chart and begin offering services. Please make sure that you provide complete answers to each question.

  Down Load Form Here (.PDF)>>

• Notice of Privacy Practices (Required)
  When completed, this statement acknowledges that you have received a copy of our Privacy Statement. It also tells us how you want to be contacted for communication of lab results and other information.

  Down Load Form Here (.PDF)>>

   

• Release of Information (Optional)
  When completed, this form authorizes us to release specific health information about you to others for special purposes.  Use it only if you have a specific need to share your health information with others who don't normally have access to your health records (see Privacy Statement).